Whenever someone posts a comment on my blog, I get an email about it, even if it is an old post. I was thrilled to get this comment today from Tim on the post about UHC's new FAI ruling:
"I just had my 2nd level appeal hearing with UHC today. Great news! They called back within 15 minutes and have agreed to pay for the surgery I had last September"
Congratulations Tim!!! I hope to get more news like this very soon from many readers!!!
9 comments:
This is the best news I've had in a long time...thanks for sharing it! I'm scheduled for surgery in April, and I'm already pulling information together for my appeal so I don't have to do as much work while I'm recovering. Thanks for providing such valuable information for all of us "covered" by UHC!
Chris
Yes, great news! Email Suzi to get information on a lit review that was done to support the use of this surgery for FAI.
I also just had a second appeal last week for two FAI surgeries May and July 2009. Unfortunately mine was denied. Here's to hoping my last chance is a success!
Carolina
Tim, congratulations on your success! Just curious if you followed a certain format on your appeal that might help others.
Jacki
Susie Thank you for starting this blog.
I beleive my surgery got covered for the following reasons:
1. UHC failed to notify me, my employer or my agent of the reduction in coverage when the new policy was put in place that considers arthroscopic hip surgery unproven.
2. My Dr.'s office called and gave the specific CPT codes on 9/2/09 and were not notifed of the new policy.
3. I had my Dr. send the Letter of Medical Necessity to UHC.
4. I contacted the Department of Insurance after my initial appeal was denied. They were in the process of getting the phone records between the Sugeons office and UHC prior to surgery.
5. I had the Medical Coder from the doctors office on my Hearing call.
6. I told the hearing committee that according to my secific policy UHC had descretion in covering this "unproven surgery" It meet all the requiremtns spelled out in the policy.
7. I also told them it was my understanding that UHC now covers the labrial debridementportion but not the osteoplasty portion of the surgery.
Unfortunatly I will probally have to go through this entire appeal process at least two more times:
My right side surgery failed because of very poor joint spacing. I had to go to Vail Colorado to get the correct diagnosis. Dr. Philippon will be performing reconstruction surgery using my IT band on my right hip in March and my left hip in August.
Thanks for your support.
Tim
Hi all -
Glad to have found your blog about hip labral tears and arthroscopy. I go in for surgery with Dr. Brian White (trained under Phillipon) next Friday. I, too, have UHC for health "insurance"...my surgeon requires that I apy out of pocket and haggle with UHC on my own. this info will help! I've already asked UHC, in writing, to give me a written opinion about whether they'll cover this or not. Am waiting to hear anything from them...!
Last anonymous posting -
I am also having FAI surgery with Dr. Brian White soon and have UHC! Please e-mail me...I would love to stay in touch with you throughout this process.
kszmyd@q.com
Krissa
I just received a letter from the Department of Insurnce. The day after UHC paid for my surgery, UHC updated their FAI policy effective 02/26/10.
Policy Number 2010T0530B
"Surgical treatment, both arthroscopic and open, for femoroacetabular impingement (FA) syndrome is proven"
We took on a Giant and beat him!
Tim- Thats AWESOME!!!!!!!! I'm posting it right now!!!!!
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